Anterior Hip Replacement - What is it All About?

As a Fellowship Trained Joint Replacement Surgeon, Ithat time. By using specialized instrumentation, newer
am often asked about the latest developments ingeneration hip implants, a custom operating table, and
arthritis surgery. With the advent of minimally invasivereal time intraoperative x-ray equipment, anterior hip
techniques in orthopedic surgery there has been areplacement has made a resurgence. These additions
renewed interest in performing hip replacementhave allowed the the anterior approach to become
through the front (anterior) of the hip as opposed toeasier and more reliable to perform than before.
the more traditional posterior, or backside approach.What are the drawbacks to anterior hip replacement?
The logic behind anterior hip replacement is to try toPerforming an anterior total hip replacement requires
minimize muscle damage by separating muscles topositioning on a special operating table with the legs
gain access to the front of the hip as opposed toattached directly to the table. By manipulating the
releasing and repairing the muscles to gain access totable, the leg is positioned to insert the hip stem.
the hip joint form behind. In short, there is no perfectSince it is difficult to judge how much force is applied
way to deliver implants to the hip joint. If thereto the leg, fractures in the leg bones have occurred
were, we would all be performing that approach onlyon the operating table. The implants are placed using
for hip replacement surgery. Having given you thisreal time x-ray equipment; if that equipment is
background, these are the most frequently askedmalpositioned the implants can be misplaced leading to
questions encountered in my office:potential increased wear or dislocation and a painful
Is anterior hip replacement a new technique?joint.
No. The anterior hip approach was first described byIs it true that hips done through an anterior approach
Smith-Petersen in 1917. It was used by the Frenchwill not dislocate?
surgeon, Robert Judet, in 1947 to perform an isolatedNo. All hip replacements can dislocate. Historically, the
femoral head replacement. This later evolved intoincidence of dislocation from an anterior approach is
other French surgeons performing complete hip jointless than through a posterior approach. However with
replacements through an anterior exposure in thea new generation of hip replacements, the use of
1960's.larger femoral head replacements has reduced the
If this technique has been in existence since 1960,incidence of hip dislocations for all approaches.
why all the interest now?What hip approach do you recommend?
Early surgeons found that the visualization of the hipI recommend finding a surgeon who is versed in
socket was excellent through the front of the hip;anterior, posterior, and anterolateral hip replacement.
however it was very difficult to insert a long straightSince every hip exposure has specific pros and cons,
metal stem down the femur through an anteriorit is the job of the surgeon to match each individual
approach. If complications occurred during surgery itpatient's need to the specific approach. Patients and
was very difficult to change or extend the anteriorsurgeons want to minimize pain and speed recovery,
approach to overcome difficult surgeries and provideyet the main objective of hip replacement is to
for better visualization. Therefore, most surgeonsprovide patients with a well done operation, with
opted to perform hip replacement through posterior,good component position, and the expectation that it
or posterior and lateral exposures. The posteriorwill last for the next 20-30 years.
approach has become the standard of care since